MEDICARE: KYLIE MICHELLE MCCONVILLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	A188499	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1639829500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE MICHELLE MCCONVILLE MD

Provider Business Mailing Address
First Line	:	505 PARNASSUS AVE # 114
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 4TH ST STE 252
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94158-2324
Country	:	US
Telephone Number	:	415-353-2069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/20/2026

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